The incidence of depression and anxiety in patients with ankylosing spondylitis: a systematic review and meta-analysis

Abstract

Background: As awareness for the importance of mental health continues to expand in rheumatology, it is important to understand the epidemiology of psychiatric complications in ankylosing spondylitis (AS) with the ultimate goal of future prevention and improved quality of care. This study aims to review evidence on the incidence and determinants of depression and/or anxiety among patients with AS. Methods: We searched Medline, Embase, Cochrane Database of Systematic Reviews, CINAHL Complete, and PsycINFO for full-length observational studies that involved a sample or population of patients with AS and assessed depression and/or anxiety. Primary outcomes extracted were: 1) risk estimates for depression and/or anxiety (e.g., relative risk [RR]); and 2) determinants or factors identified as independent predictors of depression and/or anxiety using multivariable regression approaches and corresponding estimates (e.g., odds ratios [OR]). Where relevant, we pooled estimates using random effects models. Results: Out of 783 titles from our search strategy, we reviewed 39 manuscripts. Four studies assessed the incidence of depression and meta-analyzing reported estimates from three of these studies yielded a pooled RR of 1.51 (95% CI 1.28 to 1.79). Differences in risk of depression among men and women with AS were inconclusive, suggesting need for further study. The incidence of anxiety was comparatively less studied with only one included study reporting a hazard ratio of 1.85 (95% CI 1.37 to 2.49). Education level was a key determinant, with lower levels associated with higher odds of depression (OR 6.65; 9% CI 1.36 to 32.51) and anxiety (OR 9.31; 9% CI 1.39 to 62.19) among AS patients. Conclusions: Our systematic review and meta-analysis shows an increased risk of depression and anxiety among patients with AS. These findings suggest the importance of monitoring and care for psychiatric conditions in AS.

Introduction and switching of biologic agents are associated with antidepressant and anxiolytic medication use: data on 42 815 real-world patients with inflammatory rheumatic disease

“…Interestingly, increased peripheral inflammatory markers were more common among anti-depressant non-responders compared with responders. 8 Furthermore, it is well 2846 (28) 3813 2531 291 257 226 174 215 (2) Other csDMARDs (%) 205 (11) 703 (7) 649 4382 (27) 929 (21) 366 (14) 166 (8) 292 (8) 74 7bDMARDs (17) 1554 (15) 2095 (14) 338 (24) 972 (22) 409 (16) 180 (8) 410 (11) 97 (10) Glucocorticoids (%) (12) 2394 (23) 3988 (26) 143 (10) 834 (19) 591 (23) 235 (11) 673 (18) 208 (21) bDMARD, biologic DMARD; cDMARD, conventional synthetic DMARD; DMARD, disease modifying anti-rheumatic drugs; TNF, tumour necrosis factor. 281 (6) 310 (5) 193 (17) 370 (12) 134 (10) 406 (20) 471 (14) 119 (13) Female (%)…”

“…18 Likewise, patients with AS and PsA showed higher rates of anxiolytic usage compared with patients with RA. So far, metaanalyses and cohort studies have shown higher odds for depression among patients with RA, PsA and AS [19][20][21][22] compared with the general population. Depression in rheumatic diseases has been associated with impaired health-related quality of life, 23 worse response to treatment and lower improvement in disease activity over time.…”

Depression in patients with spondyloarthritis: prevalence, incidence, risk factors, mechanisms and management

“…In one meta-analysis, the pooled prevalence of depression in AS was reported to be 29%. 37 However, findings from this meta-analysis were largely driven by one large study from Taiwan comprising 11,701 patients, 39 which used the Elixhauser comorbidity index to record ICD-9 identified diagnoses of depression, 40 rather than direct assessment of mood using a validated scale/interview. Reliance on clinical diagnosis can lack temporal validity, provides no information on current symptom severity, and may underestimate prevalence due to subthreshold and undiagnosed depression.…”

“… 37 , 44 Comprising 5947 patients with AS from three studies conducted in Taiwan, Sweden and the United States (US), a pooled rate ratio (RR) for depression in AS was 1.51 (95% CI, 1.28–1.79). 37 This 51% increase in risk was calculated based on studies that report incidence rates within 1 year, 45 10 years, 46 and 13 years of developing AS. 47 Smoking and lower education were reported to be associated with a higher risk of depression.…”

Ankylosing spondylitis is associated with an increased risk of dementia: A systematic review and meta‐analysis

“…9,10 AS is also known to be associated with depression, which could predispose affected individuals to dementia later in life. [11][12][13] Moreover, patients with AS could have limited physical activity which is another risk factor of dementia. 14,15 However, specific data on the relationship between AS and dementia are still conflicting.…”